Eastern State Hospital has the honor of being the first public facility in the United States constructed solely for the care and treatment of the mentally ill. In the summer of 1770, Colonial legislators met in Williamsburg, the capital of the Virginia colony, and passed a bill authorizing the construction of a hospital for this purpose. The building was erected on an eight-acre site near the College of William and Mary, and the first patients were admitted on October 12, 1773.

The Hospital provided treatment during the turbulent crises of both the Revolutionary War and the War Between the States. By the mid-1930s, Eastern State Hospital had expanded significantly from its early beginnings. Because of the embellishment of Colonial Williamsburg by the Rockefeller family, there was a need to relocate the Hospital from its downtown site to more spacious surroundings. Dunbar Farms, which was located approximately three miles to the west, was chosen as the new site. This move was accomplished on a gradual basis and completed in 1970.

The Civil War devastated Eastern State, destroying the advanced therapeutic community Dr. Galt had nourished. The Hospital found itself on one side, then another, of the battle lines. One of the displays is a fragment from one of Dr. Galt's journals. The January 4, 1862 entry reads, "Mr. Miller said he had conversed with Mr. Saunders about the expected attack on the asylum," and then trails off mysteriously unfinished. It is the most recent writing of Dr. Galt held in the Library's collection. Robert Saunders was a member of the Court of Directors, and his April 5, 1862 note to Hospital Steward William Douglas illustrates the innumerable small ways in which the war disrupted lives. The Hospital was finally captured May 6, 1862, and Dr. Galt died soon after, on May 17 or 18. He had probably suffered from depression for many years, and either accidentally or purposely overdosed on laudanum, which he liberally dispensed to his patients as a neuroletic substitute.

In 1841 the Hospital, called Eastern Lunatic Asylum and housing 125 "inmates," came under the supervison of Dr. John Galt, an incontrovertibly brilliant physician who brought the full flower of Moral Management treatment to Williamsburg. As Dr. Galt put it, three successive revolutions in psychiatry occured in Williamsburg. The "First Revolution" was the Hospital's founding as a publicly supported facility exclusively for the care of the mentally ill. The "Second Revolution" was the introduction of Moral Management therapy. This taught, as Dr. Galt said, that the mentally ill "differ from us in degree, but not in kind" and are entitled to human dignity. Dr. Galt introduced therapeutic activities and talk therapy. He was probably alone among contemporary asylum superintendants to advocate that the psychiatric hospital undertake in-house research and claimed to treat African-American patients on an equal footing with whites. Dr. Galt used restraint very sparingly (one year restraining none) and sought a calming medication to replace restraint. He dispensed opium liberally to patients in a foreshadowing of our twentieth century neuroleptics.The "Third Revolution in Psychiatry" became clear in 1857, when Dr. Galt was the first to advocate deinstitutionalization and community-based mental health care. He wrote, "A large number of insane, instead of rusting out their lives in the confines of some vast asylum, should be placed... in the neighboring community... were any other class of persons than the insane collected together in such large numbers as is the case in some asylums, we are satisfied that the greatest disorder would be likely to ensue." Dr. Galt's was a lone voice, over a century ahead of its time--there were no echoes of agreement beyond his office, and the Hospital's Court of Directors three times prevented his accomplishing these plans. His disappointment and consequent depression probably contributed to his suicide five years later.

Thus, it was that at Eastern State Hospital all the components of the modern psychiatric hospital may have first been put into practice--human dignity for the mentally ill, therapeutic activities, talk therapy, calming medication, in-house research, deinstitutionalization, and community-based mental health care.

Symptoms of a Dysfunctional Age: The Nineteenth Century in America was characterized by a lack of civil rights for the majority of the people. There was slavery for African-Americans and oppression of women and children, as well as tremendous stigma against the mentally ill. The list of servants is actually a list of slaves owned by Eastern State Hospital around 1850. There were as many as 45 slaves working at the asylum, and they appear to have taken a large share in the work to be done. Dr. Galt trained them, as well as white "officers" (nursing aides, currently termed Human Services Care Workers), to provide talk therapy for the patients, although Dorothea Dix disapproved. Eastern State had been an integrated hospital since its beginning in 1773, and in 1846 Dr. Galt successfully submitted a bill to admit slaves as patients.

Dr. Galt claimed to treat patients equally "without regard to race." In fact, he published no records as to the racial breakdown of the patient population. The mentally ill were another group suffering oppression at this time. Chaining and other forms of long-term restraint were common at Eastern Lunatic Asylum until the late 1830s, when Moral Management thinking introduced the ideals of human dignity and least restraint. In some years, Dr. Galt used no restraints at all. However, patients that escape were sometimes cruelly treated by the surrounding community. The letter dated September 4, 1843 is a bill for the castration of an Eastern State patient who was captured near Lynchburg, Virginia. Dr. Galt's reaction (he was then 23) is not known, but he did not send payment.

Letters

This routine piece of correspondence between two founding members of the American Psychiatric Association has many relatives. Frequently Dr. Stribling (whose Staunton, Virginia asylum was founded in 1828) refused transfer patients from Williamsburg, and, perhaps almost as frequently, Dr. Galt returned the favor. It is not known what was the race of the "man" Dr. Galt wished to transfer. If Dr. Stribling knew him to be African-American, that would have been sufficient reason for the refusal, as the Western Lunatic Asylum was not desegregated until 1968.

Eastern State Hospital 1853 and 1935 - Assorted Documents

The first of two routine documents from the 1850s is a leave slip submitted by Somersett Moore in 1855. Seven years later Moore, whose position was perhaps similar to a charge aide's, was the only non-African-American employee who returned to the Hospital when it was captured by Union troops in May 1862. All other white employees ran away and locked up the 252 patients, leaving them to starve. Mr. Moore saved their lives by giving the Hospital keys to the Northerners. The second document is a letter of Galt's to the Court of Directors which independently administered the then Eastern Lunatic Asylum, in which he expressed apparently chauvinistic opinions concerning the ability of a woman to be an officer (human services care worker).

The April 17, 1935 letter copy from the Virginia Governor's office shows the convergence of the interests of Eastern State Hospital and Colonial Willliamsburg regarding the relocation of the Hospital to its present site at Dunbar. ESH's "emergency" was overcrowding - over 2000 patients lived downtown and there was no more room for more buildings. Colonial Williamsburg viewed the patients as "noisy" and destructive of the atmosphere of the restored area and the Williamsburg Inn where well-to-do tourists stayed. The first patient care buildings were constructed and inhabited at Dunbar in 1937.

Fragment from Notes for "The Farm of St. Anne"

These preliminary notes, probably from 1854, outline some of Dr. Galt's principal thoughts for this important essay which was published in the American Journal of Insanity in 1855. "I am satisfied that the insane, generally, are susceptible of much more extended liberty than they are now allowed," he wrote in the essay. Earlier, in 1847, he wrote that it was "fully as important an indication after a while to separate a maniac from the associations of the hospital as of those at home."

Dr. Galt drew inspiration from the experimental farm of St. Anne at the French asylum of Bicetre, and the Belgian village Gheel. He envisioned the mentally ill living in supervised group homes, boarding with community members, or living independently and working where possible. Some of these independent living arrangements should be relatively close to the asylum to ensure the availability of care. In particular Dr. Galt wished to remove from the asylum harmless chronic patients.

This proposal stirred some controversy among members of the American Psychiatric Association. Matters were not helped when Galt reflected upon other American asylums and found them to be prison-like, nor did his characterization of his fellow asylum superintendents "tinkering with gas pipes and studying architecture." Thomas Kirkbride in particular felt himself a target, writing that Galt had "little idea of the restraint really necessary for recent cases and that [visitors to Eastern State] know why so much liberty is permitted between townspeople and the patients, which certainly is not seen in any other institution in the country." Kirkbride's sharp remark refers to Dr. Galt's ten-year experiment with deinstitutionalization in Williamsburg. From 1841 until 1852, half of the Hospital's 280 patients had the freedom of the town at all times, and the townspeople were encouraged to visit and socialize with the patients still confined to the grounds. Considerable enlightenment must be ascribed to the locals. How many towns today would support this experiment?

Letter from Dr. Kirkbride, Pennsylvania Hospital for the Insane, to Dr. Galt

This routine correspondence, dated September 22, 1852, shows that Dr. Galt and Dr. Kirkbride (both founding members of the American Psychiatric Association) were on good terms when not disputing issues of deinstitutionalization. Kirkbride is requesting specifications so that he may commission for Galt a zinc dial set for the latitude of Williamsburg.

The Patients' Library is the oldest library of its kind in a public psychiatric hospital. The purchase authorization from the Court of Directors places the Library's founding date exactly--August 31, 1843. Dr. Galt was one of the earliest to write about what we now call bibliotherapy. In a lecture (later published) entitled "On Reading, Recreation, and Amusements for the Insane," which was presented at the American Psychiatric Association's 1848 meeting, Dr. Galt noted the therapeutic value of reading in the treatment of mental illness. As "The Bibliography of Insanity" illustrates, he also advocated the establishment of medical libraries at psychiatric hospitals. Eastern State's medical library was housed in Dr. Galt's home during his superintendency, and fragments survive at Colonial Williamsburg's Foundation Library. Both of Dr. Galt's libraries continue to this day.

Treatment: 18th Century vs. 19th Century

The letter of August 11, 1793 describes a visit to Bethlehem psychiatric hospital in London, the namesake for our word "bedlam." Although it seems to be by the hand of Dr. John Galt II, it must be a copy as it precedes his birth by a quarter century. Although there were harsh medical measures like bleeding (and the ever-present restraints), there was little effective treatment. The role of the psychiatric hospital as public entertainment should also be noted--the writer expressed disappointment in being unable to view Margaret Nicholson, who had been admitted there after attempting to assassinate King George III, and who had enhanced her notoriety with a ghost-written best-seller.

The 1793 letter's remark about the relative lack of restraint and presence of only a few recreational activities at Bethlehem shows the influence of a new way of looking at mental illness, Moral Management, which began about this time. Moral Management arose from the same intellectual conditions as the French Revolution's "liberty, equality and fraternity." The mentally ill were, as Dr. Galt wrote, different from us "... only in degree, not in kind" and were to be treated with dignity, kindness, socialization, talk therapy, therapeutic activities, and the least possible restraint. Much experimentation went on in search of effective medication, and a staff-patient ratio of 1:1 was recommended, although Dr. Galt achieved a ratio of only 1:2. The Circular of 1846 was distributed by Dr. Galt to advertise for out-of-state paying patients, and summarized the Moral Management treatment modalities that Eastern State provided. Note Dr. Galt's promise that paying patients would be assured separation from patients of lower socioeconomic backgrounds. Also some attendants were hired specifically to provide talk therapy.

Screening Form, After 1852

This form, first printed by Dr. Galt in 1852, was used inparticular by local community and healthcare officials to provide information for an initial assessment. It would have been forwarded to Williamsburg where the final determination for admission was made. Many criteria, such as danger to self or others and family history of mental illness, are still used by the Hospital today.